超声引导腹主动脉球囊阻断在凶险性前置胎盘剖宫产术中的应用

Application of ultrasound guide abdominal aorta balloon occlusion in caesarean section for pernicious placenta previa

目的探讨超声引导腹主动脉球囊阻断在凶险性前置胎盘(PPP)剖宫产术中应用的价值。方法回顾性分析2017年1月至2018年11月该院产科收治的59例PPP患者的临床资料,将2018年2-11月行超声引导腹主动脉球囊阻断剖宫产术患者20例定为球囊组,将2017年1月至2018年1月行常规剖宫产术39例定为对照组。比较两组患者的术中出血量、输血量、子宫切除率、胎儿Apgar评分、术后并发症、转ICU率及术后住院时间。结果球囊组术中出血量及输血量分别为(775.00±193.65)、(477.50±119.31)mL,明显低于对照组的(2015.38±1260.02)、(1496.92±935.87)mL,两组患者比较差异均有统计学意义(P<0.05)。球囊组患者术后转ICU率、术后住院时间均明显低于对照组,两组患者比较差异有统计学意义[5.00%vs.41.03%、(6.85±2.82)d vs.(10.67±3.99)d,P<0.05]。两组患者的子宫切除率及胎儿Apgar评分比较,差异均无统计学意义(P>0.05)。球囊组1例患者术后出现右髂外动脉血栓,经抗凝治疗后好转。结论PPP剖宫产术前经超声引导行腹主动脉球囊阻断可有效减少术中出血量及输血量,技术安全可靠,值得临床推广。

Objective To explore the application value of ultrasound guided abdominal aorta balloon occlusion in caesarean section for pernicious placenta previa(PPP).Methods The clinical data of 59 patients with PPP treated in the obstetrics department of this hospital from January 2017 to November 2018 were retrospectively analyzed.Twenty cases of ultrasound guided abdominal aorta balloon occlusion combined with cesarean section from February to November 2018 were classified as the balloon group,and 39 of conventional cesarean section from January 2017 to January 2018 as the control group.The intraoperative bleeding volume,blood transfusion volume,hysterectomy rate,fetal Apgar score,postoperative complications,ICU conversion rate and postoperative hospitalization days were compared between the two groups.Results The intraoperative bleeding volume and blood transfusion volume in the balloon group were(775.00±193.65)mL and(477.50±119.31)mL respectively,which were significantly lower than(2015.38±1260.02)mL and(1496.92±935.87)mL in the control group,the differences between the two groups were statistically significant(P<0.05).The ICU conversion rate and postoperative hospitalization days in the balloon group were significantly lower than those in the control group,and the differences between the two groups were statistically significant[5.00%vs.41.03%,(6.85±2.82)d vs.(10.67±3.99)d,P<0.05].There was no statistically significant differences in the hysterectomy rate and fetal Apgar score between the two groups(P>0.05).One case in the balloon group appeared right external iliac artery thrombosis after operation,which was improved after anticoagulant therapy.Conclusion The ultrasound guided abdominal aorta balloon occlusion techniquein caesarean section for PPP can effectively reduce the amounts of intraoperative bleeding and blood transfusion,the technique is safe,reliable and worthy of being widely applied in clinic.